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Researchers are calling for a different strategy to eradicate polio in countries where the disease remains endemic, namely, Nigeria, Pakistan and Afghanistan. They say greater community involvement and stronger health systems are needed.

All three countries where polio remains entrenched face attack by militants, political unrest and a lack of trust among the populations.

Dr. Seye Abimbola -- of Nigeria’s National Primary Health Care Development Agency – is one of the authors of two articles that appear in PLOS Medicine. He says it’s time to move away from – what’s called – a leader-centric approach to polio eradication.

“It’s the sort of way of doing things that isn’t quite people-centric enough. The people that we are trying to reach with vaccines for polio – they are children – they are parents. Those parents have concerns, often valid concerns about the safety of the vaccines, for example. [And] about other issues, social-economic issues in their lives, for example.”

He said parents often have health issues on their minds other than polio.

“They have bigger problems. Big problems, for example, like pneumonia, malaria, and diarrhea. You see a family, who in the past six months [has] lost a child or two to these diseases. But the government of the country keeps coming, keeps offering vaccines. It gets to a point where the mother would wonder – this is not the only problem I have. What are you doing about other problems? This sort of resistance is quite logical.”

Abimbola said that polio immunization should be part of a larger health and development intervention program. He writes that “the ambition of the global health community to eradicate polio appears to be blinding it to lessons learned about health systems over the past 30 years.” He adds, “Polio eradication will only be achieved with stronger health systems and bottom-up community engagement.”

“I think it’s even more important now than ever. There’s a lot of distrust and I think one of the most important ways to address distrust is to actually see the other party – not as an opponent, not as an enemy – but as a human being with legitimate concerns that can be aired, that can be understood and can be addressed,” he said.

He said it’s important to somehow persuade militant groups that health interventions are necessary. For example, aid agencies say there have been cases where even the Taliban in Afghanistan has endorsed polio immunization campaigns.

“The reason why the Taliban does it in in Afghanistan is because the Taliban sees itself as a government in waiting. And when a militant group wants the people’s trust they go at it by trying to do what the people want. So if you can make the people want the services that we are offering we hope that these militant groups, who are trying to get some legitimacy, would see ensuring access to these services as a way of getting legitimacy, rather than as a way of imposing themselves on the people,” he said.

Creating stronger health systems and increasing community engagement, he says, will require more time and investment than currently exists in Afghanistan, Pakistan and Nigeria. Co-authors of the article are from Afghanistan and Pakistan.

In a separate article in PLOS Medicine, authors stressed the importance of Lady Health Workers in Pakistan. There are about 106,000 women who have that official title. They assist in immunization efforts, child birth, family planning, nutritional advice, hygiene and pre-natal care.

However, the article said they are often in “desperate financial straits” with little opportunity for career advancement. And they often put their lives at risk during immunization campaigns in areas where militants are based.

The article said instead of treating them as “disposable labor,” they should be “well-supported, active partners in achieving a healthier Pakistan.”

The authors are from Middlebury College in the U.S. and Aga Khan University in Pakistan.

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